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Anxiety

Fear and its associated reactions (freeze, flight, fight) can be useful responses to a dangerous or threatening situation. However, clients suffering from anxiety disorders experience these reactions too strongly, too often, or in inappropriate situations - and they can be distressing and exhausting. Psychology Tools can help you with CBT for anxiety - our anxiety worksheets are designed to help clients with generalized anxiety disorder (GAD), health anxiety (hypochondriasis), panic disorder, phobias, and social anxiety. Read more
Anxiety
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What Keeps Depersonalization And Derealization Going?

What Keeps Depersonalization And Derealization Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-depersonalization-and-derealization-going

Information handouts

What Keeps Fears And Phobias Going?

What Keeps Fears And Phobias Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-fears-and-phobias-going

Information handouts

What Keeps Generalized Anxiety And Worry Going?

What Keeps Generalized Anxiety And Worry Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-generalized-anxiety-and-worry-going

Information handouts

What Keeps Health Anxiety Going?

What Keeps Health Anxiety Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-health-anxiety-going

Information handouts

What Keeps Low Self-Esteem Going?

What Keeps Low Self-Esteem Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-low-self-esteem-going

Information handouts

What Keeps Obsessive Compulsive Disorder (OCD) Going?

What Keeps Obsessive Compulsive Disorder (OCD) Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-obsessive-compulsive-disorder-ocd-going

Information handouts

What Keeps Panic Going?

What Keeps Panic Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-panic-going

Information handouts

What Keeps Post-Traumatic Stress Disorder (PTSD) Going?

What Keeps Post-Traumatic Stress Disorder (PTSD) Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-post-traumatic-stress-disorder-ptsd-going

Information handouts

What Keeps Social Anxiety Going?

What Keeps Social Anxiety Going?

The "What Keeps It Going?" series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, t ... https://www.psychologytools.com/resource/what-keeps-social-anxiety-going

Information handouts

Why Do I Keep Getting Panic Attacks? (Psychology Tools For Overcoming Panic)

Why Do I Keep Getting Panic Attacks? (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter describes how ... https://www.psychologytools.com/resource/why-do-i-keep-getting-panic-attacks-psychology-tools-for-overcoming-panic

Books & Chapters

Window Of Tolerance

Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

Information handouts

Working With Anxious Thoughts And Predictions (Psychology Tools For Overcoming Panic)

Working With Anxious Thoughts And Predictions (Psychology Tools For Overcoming Panic)

Psychology Tools for Overcoming Panic takes a cognitive behavioral therapy (CBT) approach to this common anxiety problem. This chapter introduces the ... https://www.psychologytools.com/resource/working-with-anxious-thoughts-and-predictions-psychology-tools-for-overcoming-panic

Books & Chapters

Worry – Self-Monitoring Record

Worry – Self-Monitoring Record

The Worry – Self-Monitoring Record worksheet is designed to help clients capture information about situations where they engaged in worry. Consisten ... https://www.psychologytools.com/resource/worry-self-monitoring-record

Worksheets

Worry Decision Tree

Worry Decision Tree

Worry is a cognitive process that involves thinking about problems that might happen in a way that can leave you feeling anxious or apprehensive. Not ... https://www.psychologytools.com/resource/worry-decision-tree

Exercises

Worry Diary (Archived)

Worry Diary (Archived)

NOTE: An improved version of this resource is available here: Worry – Self-Monitoring Record. Older versions of a resource may be archived in t ... https://www.psychologytools.com/resource/worry-diary-archived

Archived

Worry Postponement

Worry Postponement

Worry postponement ("worry time") is often prescribed as an exploratory or standalone intervention relatively early in the treatment of GAD, but  ... https://www.psychologytools.com/resource/worry-postponement

Exercises

Worry Thought Record

Worry Thought Record

Anxiety stems from negative predictions about the future (and also from assumptions that one will not be able to cope with the magnitude of the threat ... https://www.psychologytools.com/resource/worry-thought-record

Worksheets

Your Stone Age Brain

Your Stone Age Brain

Your Stone Age Brain is an information handout which describes the freeze-flight-fight response: a set of evolutionary adaptations that increase the c ... https://www.psychologytools.com/resource/your-stone-age-brain

Information handouts

Your Stone Age Brain (CYP)

Your Stone Age Brain (CYP)

Your Stone Age Brain is an information handout designed to stimulate discussion with anxious children & adolescents. It describes the freeze-fligh ... https://www.psychologytools.com/resource/your-stone-age-brain-cyp

Information handouts

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Assessment

  • Brief Fear Of Negative Evaluation Scale | Leary | 1983
  • Fear Questionnaire (FQ) (Phobia) | Marks, Matthews | 1979
    • Scale download archived copy
    • Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17(3), 263-267.
  • Generalized Anxiety Disorder 7-item (GAD-7) | Spitzer, Kroenke, Williams, Lowe | 2006
    • Scale  download
    • Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.
  • Hamilton Rating Scale For Anxiety (HAM-A) | Hamilton | 1959
    • Scale download archived copy
    • Hamilton, M. (1959).The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50-55.
  • Health Anxiety Inventory (HAI) | Salkovskis, Rimes, Warwick, Clark | 2002
    • Scale download
    • Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(05), 843-853.
  • Liebowitz Social Anxiety Scale (LSAS-SR) | Liebowitz | 1987
  • Mobility Inventory For Agoraphobia (MIA) | Chambless, Caputo, Jasin, Gracely, Williams | 1985
    • Scale download  archived copy
    • Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour research and therapy, 23(1), 35-44.
  • Panic Disorder Severity Scale (PDSS) | Shear, Brown, Barlow, Money, Sholomskas, Woods, Gorman, Papp | 1997
    • Scale download archived copy
    • Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … & Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154(11), 1571-1575.
  • Penn State Worry Questionnaire | Meyer, Miller, Metzger, Borkovec | 1990
    • Scale download archive.org
    • Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487-495.
  • Spence Children’s Anxiety Scale | Spence | 1998
  • Severity Measure For Agoraphobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebu | 2013
  • Severity Measure For Generalized Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Severity Measure For Panic Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Severity Measure For Social Anxiety Disorder | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Severity Measure For Specific Phobia | Craske, Wittchen, Bogels, Stein, Andrews, Lebeu | 2013
  • Social Phobia Inventory (SPIN) | Connor, Davidson, Churchill, Sherwood, Weisler, Foa | 2000
  • Social Phobia Scale | Mattick, Clarke | 1995

Intervention

Treatment guidelines

  • NICE guidelines for GAD and panic | 2011  download
  • NICE guidelines for social anxiety disorder | 2013  download

Treatment manuals

  • Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Ledley, Foa, Huppert, Clark | 2006  download
  • Treatment manual for panic disorder (IAPT treatment manual for high intensity CBT therapists) | Clark, Salkovskis | 2009 download archived copy
  • A brief cognitive-behavioural treatment for social anxiety disorder | Morris, Mensink, Stewart  download  archived copy

Useful resources

  • Assertive defense of the self | Padesky | 1985 download archived copy
  • Interoceptive exposure definition | White, Basden, Barlow download archived copy
  • Task concentration training definition | Bögels download archived copy
  • Task concentration training and fear of blushing | Bögels, Mulkens, De Jong | 1997 download archived copy

Information Handouts

Generalized anxiety and mindfulness

Health anxiety

Panic

Panic

  • Panic self-help booklet by | Charles Young, Alison Hunte, Jessica Newell, Pat Valian | 2011 download archived copy
  • Panic self-help booklet from Glasgow STEPS including information about panic and self-help interventions download archived copy

Phobia

  • Phobia self-help booklet from Glasgow STEPS including information about phobia and self-help interventions download archived copy

Social anxiety

Social anxiety

  • ‘Shyness and social anxiety – a self help guide’ download archived copy

Worksheets

Generalized anxiety and mindfulness

Panic

Social anxiety

Self-Help Programmes

Self-help programme for anxiety

Self-help programme for generalized anxiety and mindfulness

Self-help programme for health anxiety

  • Understanding health anxiety download
  • How health anxiety develops download
  • What keeps health anxiety going? download
  • Reducing your focus on health anxiety symptoms and worries download
  • Re-evaluating unhelpful health-related thinking download
  • Reducing checking and reassurance seeking download
  • Challenging avoidance and safety behaviors download
  • Adjusting health rules and assumptions download
  • Healthy living and self-management planning download

Self-help programme for panic

Self-help programme for social anxiety

 

Presentations

  • New developments in exposure therapy for anxiety and related disorders: the inhibitory learning approach | Blakey, Abramowitz | 2018  download archived copy
  • Desirable difficulties: optimizing exposure therapy for anxiety through inhibitory learning | Abramowitz, Jacoby, Blakey | 2018 download archived copy
  • GAD – a cognitive model and treatment download  archived copy
  • Bringing Specificity to Generalized Anxiety Disorder: Conceptualization and Treatment of GAD using Intolerance of Uncertainty as the Theme of Threat | Robichaud | 2013 download archived copy

Recommended Reading

General

  • Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 download archived copy

Generalized Anxiety Disorder

  • Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011-1023 download archived copy
  • Bottesi, G., Ghisi, M., Carraro, E., Barclay, N., Payne, R., & Freeston, M. H. (2016). Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples. Frontiers in psychology, 7, 1723 download  archived copy
  • Hirsch, C. R., Beale, S., Grey, N., & Liness, S. (2019). Approaching cognitive behavior therapy for generalized anxiety disorder from a cognitive process perspective. Frontiers in psychiatry, 10, 796. download archived copy
  • Milne, S., Lomax, C., & Freeston, M. H. (2019). A review of the relationship between intolerance of uncertainty and threat appraisal in anxiety. the Cognitive Behaviour Therapist, 12. download

A number of treatment packages have demonstrated efficacy in the treatment of GAD:

Laval model

  • Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour research and therapy, 36(2), 215-226.

Avoidance model of worry and GAD

  • Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. Generalized anxiety disorder: Advances in research and practice, 2004.
  • Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2013). Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration. Cognitive and Behavioral Practice, 20(3), 301-313 download  archived copy

Metacognitive model

  • Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2013). Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration. Cognitive and Behavioral Practice, 20(3), 301-313.
  • Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 23(3), 301-320 download  archived copy

Emotional dysregulation model

  • Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. (2013). Emotion regulation therapy for generalized anxiety disorder. Cognitive and Behavioral Practice, 20(3), 282-300 nih.gov
  • Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9(1), 85-90 download  archived copy

Acceptance-based model of GAD

  • Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance‐based approaches with existing cognitive‐behavioral models. Clinical Psychology: Science and Practice, 9(1), 54-68 download  archived copy
  • Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29(1), 71-88.

Health Anxiety

  • Asmundson, G. J. G., Abramowitz, J. S., Richter, A. A., Whedon, M. (2010). Health anxiety: current perspectives and future directions. Current Psychiatry Reports, 12, 306-312 download
  • Furer, P., Walker, J. R. (2008). Death anxiety: A cognitive behavioural approach. Journal of Cognitive Psychotherapy, 22(2), 167-182 download
  • Salkovskis, P. M., Warwick, H. M. C., Deale, A. C. (2003). Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353-367 btci.edina.clockss.org archived copy
  • Walker, J. R., Furer, P. (2008). Interoceptive exposure in the treatment of health anxiety and hypochondirasis. Journal of Cognitive Psychotherapy, 22(4), 366-378 download

Panic disorder

  • Clark, D. A. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 download archived copy
  • Huppert, J. D., & Baker-Morissette, S. L. (2003). Beyond the manual: The insider’s guide to panic control treatment. Cognitive and Behavioral Practice, 10(1), 2-13.
  • Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J. et al. (2000). Dismantling cognitive-behavioural treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417-424 download archived copy
  • Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Chichester: Wiley.

Social Anxiety Disorder

  • Clark, D. M. (2001). A cognitive perspective on social phobia download archived copy
  • Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioural Practice, 16. 123-134 download archived copy
  • Wild, Hackmann, Clark (2008). Rescripting early memories linked to negative images in social phobia: a pilot study. Behaviour Therapy, 39(1), 47-56. download
  • Veale, D. (2003). Treatment of social phobia. Advances in Psychiatric Treatment, 9, 258-264 download archived copy
  • Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A., & Clark, D. M. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and behavioral practice, 24(2), 245-255. view archived copy
  • Warnock-Parkes, E., Wild, J., Thew, G., Kerr, A., Grey, N., & Clark, D. (2022). ‘I’m unlikeable, boring, weird, foolish, inferior, inadequate’: How to address the persistent negative self-evaluations that are central to social anxiety disorder with cognitive therapy. The Cognitive Behaviour Therapist, 15, E56. doi:10.1017/S1754470X22000496 view archived copy

What Is Anxiety?

Signs and Symptoms of Anxiety Disorders

Different anxiety disorders are characterized by various foci of concern.

In addition to disorder-specific cognitive content, individuals experiencing anxiety disorders are likely to experience physical symptoms of anxiety including:

  • palpitations or accelerated heart rate
  • sweating
  • trembling or shaking
  • dry mouth
  • difficulty breathing
  • a feeling of choking
  • nausea or abdominal discomfort
  • dizziness
  • derealization or depersonalization
  • fear of losing control or passing out
  • fear of dying
  • hot flushes or cold chills
  • numbness or tingling
  • blushing
  • fear of vomiting
  • urgency or fear of urination or defecation

Psychological Models and Theories of Anxiety

One broad conceptualization of anxiety can be summarized by an ‘anxiety equation’ (Beck, Emery, & Greenberg, 1985; Salkovskis, Forrester, & Richards, 1998):

Anxiety = (perceived probability of therapy × perceived cost or awfulness of danger)

÷ (perceived ability to cope + perceived ‘rescue factors’)

Disorder-specific ‘CBT for anxiety’ cognitive models have been developed for all of the anxiety disorders. These are helpful in that they direct the therapist’s attention toward key interpretations and behaviors that act to perpetuate the anxiety disorders. For example, the critical mechanism that Clark identified in the cognitive model of panic (1986) is that body sensations are misinterpreted catastrophically as signs of danger, with concomitant effects upon emotions, behavior, and secondary cognitions.

Evidence-Based Psychological Approaches for Working with Anxiety

Cognitive behavior therapy has a strong evidence base for treating all of the anxiety disorders. Key components of CBT for anxiety interventions include exposure to the feared situations or stimulus, and an experimental approach to test the accuracy of beliefs.

Resources for Working with Anxiety

Psychology Tools resources available for working therapeutically with anxiety may include:

References

  • Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
  • Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
  • Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(S35), 53–63.

 

 

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